Celia Crumel
North East,Maryland
Summary
Claims professional with a proven track record at AmeriHealth Caritas, excelling in claims processing and enhancing provider relations. Mastered compliance management and problem-solving aptitude, significantly improving customer satisfaction. Known for professionalism and maintaining calm under pressure, adept at navigating complex policy landscapes.
Overview
14
14
years of professional experience
Work History
Provider Services Representative
AmeriHealth Caritas
02.2016 - 03.2017
- Investigated and resolved customer inquiries and complaints quickly.
- Identified and resolved discrepancies and errors in customer accounts.
- Responded to providers via telephone regarding claim discrepancies, eligibility and benefits.
Claims Processor
State Farm
03.2013 - 08.2015
- Established positive and trusting relationships with injured clients, administering efficient customer service and processing claims quickly.
- Managed workload and priorities to meet claims processing meet deadlines.
- Reviewed applications and supporting documents to verify claims eligibility and accuracy.
- Complied with regulations and guidelines related to claims processing to maintain quality and adherence to standards.
- Made contact with insurance carriers to discuss policies and individual patient benefits.
- Sent settlement checks after legal documentation was received.
Provider Services Representative
Aetna Health Insurance
09.2003 - 08.2006
- Responded proactively and positively to rapid change.
- Enhanced productivity levels by anticipating needs and delivering outstanding support.
- Developed highly empathetic client relationships and earned reputation for exceeding service standard goals.
- Maintained up-to-date knowledge of product and service changes.
Education
Bachelors Of Science In Health Sciences - Biomedical Sciences
University of Wisconsin Milwaukee
Milwaukee, WISkills
- Call center experience
- Compliance management
- Policy interpretation
- HIPAA compliance
- Provider relations
- Claims processing
- Professionalism
- Computer skills
- Attention to detail
- Problem-solving aptitude
- Calm and professional under pressure
Timeline
Provider Services Representative
AmeriHealth Caritas
02.2016 - 03.2017
Claims Processor
State Farm
03.2013 - 08.2015
Provider Services Representative
Aetna Health Insurance
09.2003 - 08.2006
Bachelors Of Science In Health Sciences - Biomedical Sciences
University of Wisconsin Milwaukee
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